The significance of intraocular pressure elevation during sleep‐related postures

Intraocular pressure and its fluctuations are associated with the development and progression of glaucoma. This review examines the potential for sleep‐related intraocular pressure elevations to contribute to the onset and progression of glaucoma. Also considered is the potential for patient education and appropriate changes in behaviour as a means of reducing exposure to elevated intraocular pressure. A PubMed search using the combination key words ‘glaucoma and sleep’ was conducted. Information was taken from representative articles from the 187 yielded from the search. Additional papers were found after accessing references in selected papers. Several studies have indicated an association between the progression of glaucoma and both lateral decubitus (side sleep) and supine sleep positions. Evidence that prone sleep positions could raise intraocular pressure to high levels suggests a similar if not stronger association. Intraocular pressure elevation and progression of glaucoma associated with sleep positions suggest that there are similar risks of progression associated with sleep‐related body postures adopted during non‐sleep activities, such as reading, watching television and sun‐bathing. Posture‐related management of patients with glaucoma, which is intended to reduce the risk or degree of progression may include the use of specially designed pillows, bed‐head elevation and recommendations to avoid postures which induce higher intraocular pressure.